1. Anticipated Benefits of using Tele-Rehabilitation Services:

• This is an easy and convenient mode of delivery.
• This system will allow the Physiotherapist to assess or follow-up with your care while visits to clinic are not possible (e.g. travelling, quarantined, temporary closure, etc
• Allows the Physiotherapist to stay up to date with your care and provide appropriate education and exercise programs.

2. Possible Disadvantages of using Tele-Rehabilitation Services:

While the Physiotherapist will use reasonable means to protect the security and confidentiality of information sent and received using Tele-Rehabilitation, because of the risks outlined below, the Physiotherapist cannot guarantee the security and confidentiality of electronic communications:

• There may be limitations in the services that can be provided through electronic communications (the Physiotherapist will not be capable of performing a hands-on physical assessment and/or treatment.
• Technology failure may prevent the Physiotherapist from being able to provide services, in which case a contact number must be provided for the Physiotherapist to contact you.
• Electronic communications may need to be disclosed in accordance with a duty to report or a court order.
  
• Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
  
• In very rare cases, security protocols (despite using PHIPA compliant platforms) may fail and result in a breach of privacy or personal records. Although reasonable efforts are taken to protect the privacy and security of electronic communication, it is not possible to completely secure the information.

3. Conditions of Using Electronic Communications

• While the Physiotherapist will attempt to review electronic communications in a timely manner, the Physiotherapist cannot provide a timeline as to when communications will be reviewed and responded to. Electronic communications will not and should not be used for medical emergencies or other time-sensitive matters.
• Prior to the commencement of the provision of services by the Physiotherapist through electronic communications, the Physiotherapist and the Patient will establish an emergency protocol to address the following:
  • Steps to be followed in the event of a technical issue that causes a disruption in the services that are being provided by the Physiotherapist; and
  • Steps to be followed in the event of a medical emergency that occurs during theprovision of services.
• The Physiotherapist is not responsible for information loss due to technical failures associated with your software or internet service provider.
• The Patient will inform the Physiotherapist of any changes in the patient’s email address, mobile phone number, or other account information necessary to communicate electronically.
• If the Patient no longer consents to the use of electronic communications by the Physiotherapist, then the Patient will provide notice of the withdrawal of consent by email or other written communication.

I acknowledge that I have read and fully understand the benefits, risks, limitations, conditions of use, and instructions for use of the selected electronic communications as described above. I understand and accept the risks outlined above to this consent form, associated with the use of the electronic communications with the Physiotherapist.

I confirm that any questions that I had regarding the provision of physiotherapy services through electronic communications have been answered by the Physiotherapist.